Registration Form


Registration Form & Northeastern Martial Arts present… the 4th Annual
…with Adam Rodgers, Survival Expert/Instructor
Join us for a fun time of learning the basics of wilderness survival and bush craft skills.
This hands-on workshop will teach you the basic skills and knowledge necessary to
stay alive and healthy in the outdoors with a minimum of gear.
Topics to be covered are:
Psychology of survival & developing the proper mindset
Shelter - shelter & cover basics
Cutting tools – demo of various knives and other cutting tools
FireCraft - basic fire making skills no matter the weather conditions
Food – various options plus finding food in the wild
Water – procuring, purifying, and unusual water sources
Getting rescued – various ways to signal for rescue
Navigation – group hike on the trails with demos / discussions
Cordage – man-made & natural cordage including useful knots
How to put together your own survival “kit”
Godfrey’s Pond (meet up at the clubhouse)
Saturday, June 13th, 2015 Workshop: 10:00am to 5:00pm
Workshop Fee: $69.00 per person (or $59 if registered by June 6th).
Please make checks out to: Adam Rodgers
Participants should bring: water / fluids, snack and /or bag lunch, comfortable outdoor clothing & hiking shoes,
sun screen, insect repellent and rain gear. We will have a grill available if you want to cook burgers or hotdogs.
Also, bring along a ferro rod and your survival knife if you have one…don’t buy one just for the workshop as we
have plenty of spares. We will have some basic survival gear for sale at the event as well.
Minimum age is 12 years. Participants 14 or younger should be accompanied by parent or guardian.
If you have questions or need more info, contact Adam Rodgers, #585-709-1312.
Name: __________________________________________
Date: _______________
Address: ________________________________________________________________________
Phone: ___________________________
Email: __________________________________
I agree that my participation in the workshop is at my own risk. I further agree that Adam Rodgers, Martin Noel, Northeastern Martial Arts
Institute,, Godfrey’s Pond and any staff or assistants shall not be liable for any damages arising from personal injuries or
property damage or loss sustained by me in or near premises where the workshop shall be conducted. Also, as a result of my participation in
the workshop, I also recognize that it shall involve physical exercise.
Signed: ______________________________________________
Date: _________________
(Parent signature required if student is under 18 yrs of age.)
Rec’d by ______________ Date __________________ Amount _____________ Cash / Check # _________